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Individual

MRS. NICHELLE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSN, NP-BC

Contact information

Practice address
49 JESSE HILL JR DR SE, ATLANTA, GA 30303-3049
(404) 251-8921
Mailing address
1052 ASHTON PARK DR, LAWRENCEVILLE, GA 30045-7277
(678) 984-6020

Taxonomy

Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
RN180557
GA
363L00000X
Nurse Practitioner
Primary
NP180557
GA

Other

Enumeration date
09/24/2019
Last updated
03/16/2026
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